HIV testing on all patients?

Quite honestly it sounds like a lot of wasted money. As a caregiver I really don't need to know if my patient has HIV or not. If there are body fluids pos HIV test or not, I'm grabbing gloves.

I agree with Casi,.and who is going to pay for this test? If there isn't a reason to test for it why do it? I wouldn't care for a pt any different knowing they are HIV positive,...if it's wet and it isn't mine I don't touch it!!!

Some hospitals make available HIV testing in the Emergency room. Patients are not required to test but have the option. HIV testing requires consent and a patient has a right to refuse. Standard precautions should be used with every patient, all the time, from start to finish. Even if someone is tested, does not mean they couldn't be the virus. They could be testing within their window period and the test comes back negative. We could create various scenarios but they would all point back to always protecting yourself, the health care worker, with using standard precautions.

The argument has also been presented in the past that health care workers should be tested and the patients should know this as well.

There is no more reason to test for HIV on admission, than there is to test every pt for Hepatitis, genetic predisposition to cancer, or type and cross every pt. All of these things "could" be useful for the pt, but barring a need to know in regards to current treatment, really are not necessary and (barring type and cross) can actual cause the pt problems, create stigma, have false results, or result in excess/inappropriate treatment.

For what purpose do we need to know HIV status, unless we are treating something closely related to it? However, barring current legislation, such tests can be used to bar people from getting insurance or for coverage for certain illness that occur during coverage. For a time just requesting an HIV test, creating problems in some individuals getting insurance. Thus the reason why we order these tests at pt request or request when there is a known need.

Several of these tests require counseling and written consent to perform, for these very reasons.

The swab test is also not commonly used for diagnosing pts with HIV. The most common tests that have widespread acceptance involve blood draws and several days turn around, for more accuracy. What do you intend to do with the false negatives or positive results and the harm that those results may cause?

OP, please explain why you think it would find it essential to know this, barring a needlestick/contamination issue?

I don't know about the 'swab' test, but there is a 'rapid test' finger stick that give results in 20 minutes ... some false positives, especially with pregnant women, but the accuracy is very, very high.

The reason for testing? Early intervention and better patient outcomes, but the truth is that many do not 'want' to know. Many seek treatment after they have been sick for a very, very long time. Many suspect they have HIV, but do not want to deal with it. Even after they know, they don't want the frequent blood draws and meds with their side affects nor the stigma and thought of having 'protected' sex (condoms) for the rest of their lives, so they go in and out of treatment.

Another reason for testing? Protection of partners. There are more knowingly 'positive' folks than you can possibly imagine that are out there having unprotected sex.

Even knowing all of this, I support NOT routinely testing for HIV. I believe that it is a patients right 'not to know' just as it is their right 'not to know' that they have cancer (even though they know...get my drift?) But I am glad that there are programs such as anonymous partner notification...because it is the partner's right to protect themselves. We all know about having protected sex, but I don't think the public is commonly aware that HIV positive folks often look healthier than the average joe these days.

Just because there is "mandated" informing of partners, doesn't mean much. People lie, don't recall (or know names), or the partners are frequently not found.

The fact is the responsible sexually active/or with other risk factors person, knows their risk, and that wants to know gets tested and will inform the partner. The irresponsible and those that don't want to know, won't cooperate.

It would be nice if we all got all tests, vaccinations, etc. done but it is not practical and does violate others rights, whether we disagree with their decisions to know or do certain things or not.

But there is no "inherent" need to test all people admitted to a hospital for HIV, any more than for some other issues, unless needed in regard to treating them. And then only the MD and personnel involved in diagnosis "need" to know.Virtually all staff in contact with infective material are required to obey common precautions.

What would make more sense is to screen all pts on admission for MRSA/VRE/C'Diff as those are common, can kill, are widespread in the population, AND CAN easily spread, despite universal precautions. I strongly suspect that more people die as a result of contamination from those in the hospital, and one could easily argue a "a need to know" status regarding them.

At my hospital we have an agreement with a community based organization that comes to the ED and offer testing to clients. These are very effective programs because as we know the ED is a place for many people to obtain primary health care. The test is done by the "finger stick" or the mouth swab and is called the ELISA test. The confirmatory test, Western Blot, is would be done to confirm a positive ELISA. The WB is done by blood and is more expensive.

Depending on your state, you may have different guidelines on how HIV testing must occur. Some components including: consent, anonymous or confidential testing, age restrictions, linking to care, etc.

Why would you want to test for this? Why one every patient?

As far as I know the testing is a voluntary thing....doing it in an E.R. is probably not the best place...but if that is where the patient feels comfortable, then that is where it shoud be, yes? And, yes, consent is required.

I used to work at a county clinic where it was well known locally that testing was done between such and such a time on Tues/Thurs, etc. People would come because they liked the anonymity of it ... they looked just like anyone else coming to the clinic for the sniffles or routine visits. The great thing about it was, if we had a preliminary positive, there was someone on staff trained to deal with it. We drew blood right away, so they could get results right away (a few days) and provided psychological counseling right away ...on the spot. Some people run off and we don't see them for several months. Others just want to be swooped up into a safe environment in which they are not judjed or criticized and find out what we're dealing with. How low is the CD4, how high is the viral load? Any opportunistic infections? Any partners that need to be notified? WE guide them through the process of getting the insurance for the medically indigenet, so the very expensive HIV meds can be paid for.

I don't even remember what question I was starting to answer :)

Just from a practical standpoint, I will agree with those who are questioning who is going to pay. I *just* had this conversation with the supervisor of the serology department at the lab I work in. When I first started working in the lab, the rapid HIV tests had a higher rate of false positives. This is no longer true, at least not for the testing methodology we use. Both the rapid and the standard (24-48 hours) are highly reliable tests.

However.....

the rapid HIV is cost prohibitive. We use it only in the case of needlesticks/fluid splash and OB patients who are in labor or have delivered and did not get proper prenatal care or refused/neglected to get the state mandated (NY) pregnancy test done.

I can't remember the figures, but it cost many times more to do the rapid than the standard, *at least where I work.*

Testing in the emergency department is an excellent idea! The CDC issued recommendations calling for HIV screening for patients aged 13-64, when the individual accesses the health care system. For many patients, the emergency department (ED) is the primary or only contact point for health care. The rapid HIV test can be done as a point of care test in the ED.

The goal with priority populations (high risk groups) is to provide them with an opportunity to get tested. Many high risk individuals, often times fear getting tested and might not go to the clinic for a HIV test because they may know everybody there?! (Stimga). One of the major goals is to have HIV testing as part of rountine health care offered in the ED. The patient still needs to consent like everything else. Anyone doing HIV testing should have training on how to deliver the test results, positive or negative. Linking patients to care is also important. Depending on the state, they may have different programs available to assist with these needs. Check out this write up by the CDC.

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5624a2.htm

So is it necessary to test patients for the health care workers benefit, No. We should all be using standard precautions. Should we test them for their own knowledge of their health and HIV status, YES if they consent to it.

Expensive test, requires patient consent, can affect their ability to get insurance if they have a positive result, assume every patient you take care of has hepatitis B (higher risk for this problem than HIV) and HIV.